渗透性降颅压对万古霉素静脉泵入治疗颅内感染患儿血药浓度的影响

Influence of permeable intracranial pressure reduction on blood concentration of intracranial infection children treated with intravenous pump of vancomycin

目的探讨渗透性降颅压对万古霉素静脉泵入治疗颅内感染患儿血药浓度的影响。方法回顾性分析2012年1月-2016年12月350例于医院接受降颅内压治疗的颅内感染患儿资料,根据治疗方案分为三组:甘露醇组145例、甘油果糖组86例、联合组(甘油果糖联合甘露醇)119例,比较三组患儿治疗效果、万古霉素血药浓度、肾小球滤过率(glomerular filtration rate,GFR)变化情况及不良反应发生率。结果联合组治疗有效率优于甘油果糖组(P<0.05);甘油果糖组起效时间长于甘露醇组和联合组(P<0.05),联合组持续时间长于甘露醇组和甘油果糖组(P<0.05);甘露醇组用药后GFR水平低于甘油果糖组和联合组(P<0.05);甘油果糖组患儿血药谷浓度最佳值15~20 mg/L的占比为39.53%,高于甘露醇组和联合组(P<0.05);甘露醇组肾功能损害和电解质紊乱发生率高于甘油果糖组和联合组(P<0.05)。结论甘油果糖联合甘露醇降颅压治疗颅内感染患儿的效果好,且不会明显影响万古霉素血药谷浓度。

OBJECTIVE To observe the influence of permeable intracranial pressure reduction on blood concentration of the intracranial infection children treated with intravenous pump of vancomycin.METHODS The data of 350 children with intracranial infection who were treated with intracranial pressure reduction from Jan 2012 to Dec 2016 were retrospectively analyzed,the children were divided into the mannitol group with 145 cases,the glycerin fructose group with 86 cases and the combined group with 119 cases(glycerin fructose combined with mannitol)according to the treatment program.The curative effect,blood concentration of vancomycin,glomerular filtration rate(GFR)and incidence of adverse reactions were observed and compared among the three groups of children.RESULTS The effective rates of treatment of the combined group was significantly higher than that of the glycerin fructose group(P<0.05);the onset time of the glycerin fructose group was significantly longer than that of the mannitol group and the combined group(P<0.05),the duration of the combined group was significantly longer than that of the glycerin fructose group and the mannitol group.The GFR of the mannitol group was significantly lower than that of the glycerin fructose group and the combined group(P<0.05);the percentage of the children with the trough blood concentration ranging between 15 and 20 mg/L was 39.53%in the glycerin fructose group,significantly higher than that in the mannitol group and the combined group(P<0.05).The incidence rates of renal function damage and electrolyte disturbance were significantly higher in the mannitol group than in the glycerin fructose group and the combined group(P<0.05).CONCLUSION Glycerin fructose combined with mannitol can achieve remarkable effect on intracranial pressure reduction of the children with intracranial infection without affecting the trough blood concentration of vancomycin.